Key result
Nurse-coordinated referral to lifestyle programs fails to improve smoking cessation over usual care in CAD.
Why the study?
Does nurse-coordinated referral to community-based lifestyle programmes improve smoking cessation rates in pre-event smokers with coronary artery disease?
RCT (n=824)
Randomized
Yes
Does nurse-coordinated referral to community-based lifestyle programmes improve smoking cessation rates in pre-event smokers with coronary artery disease?
Absolute Event Rate: 50% vs 46%
p-value: p=0.45
Nurse-coordinated referral to community-based lifestyle programs did not significantly increase smoking cessation rates over usual care; the majority of successful quitters stopped immediately after hospitalization without utilizing a dedicated cessation program.
Referral to community programs does not improve smoking cessation over usual care in CAD; confirms spontaneous post-hospitalization quitting as main driver.
OBJECTIVE: The objective of this study was to investigate the characteristics of successful quitters, their use of a smoking cessation programme and the use of other lifestyle interventions to improve lifestyle-related risk factors, within a nurse-coordinated care programme. METHODS: We used data from the multicentre randomised controlled RESPONSE-2 trial ( n=824, The Netherlands). The trial was designed to assess the efficacy of nurse-coordinated referral to a comprehensive set of up to three community-based interventions, based on smoking cessation, healthy food choices and physical activity to improve lifestyle-related risk factors in coronary artery disease patients, compared to usual care. Smoking status was assessed using urinary cotinine at baseline and 12 months follow-up. RESULTS: At 12 months follow-up, there was no statistically significant difference in cessation rates (50% intervention group vs. 46% usual care group, P=0.45). The majority of successful quitters in both groups quit immediately after hospitalisation (72% intervention group vs. 86% usual care group, P=0.29). Only 19% of successful quitters in the intervention group participated in the smoking cessation programme. However, successful quitters participated more frequently in other lifestyle programmes compared with persistent smokers (65% vs. 37%, P<0.01). CONCLUSION: The majority of patients who successfully quit smoking are those who quit immediately after hospitalisation, without a need to participate in a smoking cessation programme. Moreover, this programme was attended by only a minority of successful quitters. Successful quitters were motivated to attend other lifestyle programmes addressing healthy food choices and physical activity. Our findings support a tailored, comprehensive approach to lifestyle interventions in the secondary prevention of coronary artery disease.
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Snaterse et al. (2018) conducted an RCT in Coronary artery disease (CAD) (n=824). Nurse-coordinated referral to comprehensive community-based lifestyle programmes vs. Usual care was evaluated on Smoking cessation at 12 months (p=0.45). Nurse-coordinated referral to community-based lifestyle interventions did not significantly improve smoking cessation rates at 12 months compared to usual care in patients with coronary artery disease (50% vs. 46%, p=0.45).
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